Claim CLM-2026078007
$42,069.87
billed
$38,573.11
allowed
$33,541.83
paid
$5,031.28
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Prenatal initial visit (regime/therapy) | 424441002 | $0.00 | $0.00 |
| Normal pregnancy (finding) | 72892002 | $0.00 | $0.00 |
| Standard pregnancy test (procedure) | 252160004 | $7,166.11 | $5,016.28 |
| Ultrasound scan for fetal viability (procedure) | 169230002 | $4,049.70 | $2,834.79 |